MEDICARE: JON C AXTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	10228	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265596969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON C AXTON MD

Provider Business Mailing Address
First Line	:	PO BOX 2263
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-2263
Country	:	US
Telephone Number	:	405-942-8545
Fax Number	:	405-947-6854

Provider Business Practice Location Address
First Line	:	5300 N GRAND BLVD
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5647
Country	:	US
Telephone Number	:	405-942-8545
Fax Number	:	405-947-6854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/10/2017

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Directions to “ JON C AXTON MD” Practice Location

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